Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial.

BACKGROUND: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (ß=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (ß=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (ß=.71; P=.01) and emotional eating (ß=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (ß=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.

[Healthcare in Germany: Including Physician Assistants into the Team of Physicians]. / Gesundheitsversorgung in Deutschland durch Mitarbeit von Physician Assistants im ärztlichen Team.

BACKGROUND: Physicians in Germany are overburdened. Delegation of tasks to Physician Assistants (PA) is one way of providing relief. Although PA work in Germany since 2012, few data are available. We studied advantages and disadvantages from those physicians point of view, who cooperate with PA since years, as well as working conditions, satisfaction and duration of work processes of PA. METHOD: Semi-quantitative cross-sectional survey on a course of PA graduates and the physicians they work with since three years. Retrospective analysis of patients´ waiting time and duration of stay in an emergency department. RESULTS: Physicians were very satisfied with PA and reported a high degree of relief from workload. PA were highly satisfied with their job. Processing time in the emergency department was not longer when a PA was involved in patient care. CONCLUSION: Physicians are satisfied with PA as they are relieved from a heavy workload. More data on effectiveness and efficiency of PA in Germany are needed.

Cognitive Profile and Cardiovascular Risk Factors in Older Adults with Mild Cognitive Impairment.

The prevalence of cardiovascular risk factors (CVRFs) in the older adults population and their specific impact on their cognitive profiles still requires further research. For this purpose, a cross-sectional study was carried out to describe the presence of CVRFs and their association with cognitive performance in a sample of older adults (65-85 years old) with Mild Cognitive Impairment (MCI). Participants (n = 185) were divided into three groups concerning their cardiovascular risk level determined by the presence of different CVRFs, including Type 2 Diabetes (T2D), dyslipidemia, hypertension, and obesity. The primary outcome measures were the participant's scores in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Sociodemographic, clinical, and psychosocial data were collected. Non-parametrical statistical analyses and effect sizes were calculated. Findings revealed that a greater presence of CVRFs was not associated with a worse overall cognitive performance. High-risk patients were more likely to have significantly worse performance in the attentional domain compared to medium-risk (p = 0.029, r = 0.42) and compared to low-risk (p = 0.041, r = 0.35), specifically in the digits repetition subtest (p = 0.042). T2D alone was the CVRF associated with cognitive differences (p = 0.037, r = 0.32), possibly mediated by the duration of the condition. Consequently, a higher presence of CVRFs did not lead to a worse overall cognitive performance. However, high-risk individuals were more likely to experience cognitive impairment, particularly in the attentional domain. T2D played a significant role in these cognitive profile differences, possibly influenced by its duration.

Virtual self-conversation using motivational interviewing techniques to promote healthy eating and physical activity: A usability study.

Introduction: We aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO). Methods: Fourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0. Results: Participants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO. Conclusion: The ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

Clinical efficacy of a virtual reality tool for the treatment of obesity: study protocol of a randomised controlled trial.

INTRODUCTION: Previous research has shown that it is feasible to integrate motivational interviewing techniques with behavioural and psychological interventions for the treatment of obesity. Moreover, these combined interventions have the potential to improve health-related outcomes of people living with obesity (PLWO) and to afford maintenance of behavioural changes over time. In addition, the use of virtual reality (VR) embodiment techniques in the treatment of eating disorders and obesity has promising preliminary effectiveness. The objective of this study is to assess the clinical efficacy of a VR intervention that uses embodiment and body-swapping techniques and has been specifically developed to cover the needs of PLWO. METHODS AND ANALYSIS: A randomised control trial will be carried out with an estimated sample of 96 participants with body mass index (BMI)>30. The whole duration of the trial will be 12 months. Participants will be recruited from the external consultations of the Vall d'Hebron University Hospital and be randomly assigned to three groups. The experimental group 1 will engage in a virtual self-conversation using the ConVRself platform, the experimental group 2 will participate in a 'pre-established discourse' provided by the virtual counsellor, who will give psychoeducation advice, and the control group will continue with treatment as usual. Readiness to change, BMI, eating habits and physical activity, psychological well-being, body image satisfaction, quality of life in relation to body image, and weight bias internalisation will be assessed at baseline, post intervention, 1-week and 4-week follow-up. Finally, variables related to adherence and satisfaction with the VR tool will be evaluated for the experimental groups. ETHICS AND DISSEMINATION: This study was approved by the Research Projects Committee of the Vall d'Hebron University Hospital. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences and other events for the scientific and clinical community, and the general public. TRIAL REGISTRATION NUMBER: NCT05094557.

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature.

BACKGROUND: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. OBJECTIVE: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. METHODS: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions' effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. RESULTS: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. CONCLUSIONS: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults' sensory deficits is necessary.

The Gaze Fixation Assessed by Microperimetry: A Useful Tool for the Monitoring of the Cognitive Function in Patients with Type 2 Diabetes.

Current guidelines recommend annual screening for cognitive impairment in patients > 65 years with type 2 diabetes (T2D). The most used tool is the mini-mental state evaluation (MMSE). Retinal microperimetry is useful for detecting cognitive impairment in these patients, but there is no information regarding its usefulness as a monitoring tool. We aimed to explore the role of retinal microperimetry in the annual follow-up of the cognitive function of patients with T2D older than 65 years. MATERIALS AND METHODS: Prospective observational study, comprising patients > 65 years with T2D, attended at our center between March-October 2019. A complete neuropsychological evaluation assessed the baseline cognitive status (mild cognitive impairment, MCI, or normal, NC). Retinal microperimetry (sensitivity, gaze fixation) and MMSE were performed at baseline and after 12 months. RESULTS: Fifty-nine patients with MCI and 22 NC were identified. A significant decline in the MMSE score was observed after 12 months in the MCI group (25.74 ± 0.9 vs. 24.71 ± 1.4; p = 0.001). While no significant changes in retinal sensitivity were seen, all gaze-fixation parameters worsened at 12 months and significantly correlated with a decrease in the MMSE scores. CONCLUSION: Retinal microperimetry is useful for the monitoring of cognitive decline in patients > 65 years with T2D. Gaze fixation seems a more sensitive parameter for follow-up after 12 months than retinal sensitivity.

[Adaptation of the "Recovery Experience Questionnaire" in a Spanish sample]. / Adaptación del "Cuestionario de Experiencias de Recuperación" a una muestra española.

The aim of this work was to examine the psychometric properties of the Spanish version of the "Recovery Experience Questionnaire" developed by Sonnentag and Fritz. The sample was made up of 941 professionals from the security sector. Results from the exploratory factor analysis suggested the possibility of considering a four-factor structure. Confirmatory factor analysis showed that the four-factor model with three correlated items each provided the best fit to the data (CFI=0.97, GFI=0.96, NNFI=0.96, RMSEA=0.05 y AIC=171.76). Therefore, the questionnaire maintains the four recovery experiences -psychological detachment from work, relaxation, mastery experiences and control over leisure time--but with 12 items instead of 16 items as in the original scale. Reliability analysis showed good internal consistency for this scale with Cronbach alpha coefficients for the factors ranging from .75 to .88. Significant correlations were found between the recovery experiences and various external variables, providing evidence of construct validity. Thus, this Spanish version shows adequate psychometric properties and may help to achieve a better understanding of this topic.

Alkaloids isolated from Tropaeolum tuberosum with cytotoxic activity and apoptotic capacity in tumour cell lines.

Two alkaloids were isolated and identified for the first time in the black tubers of Tropaeolum tuberosum, collected from the Titicani-Taca, Ingavi province in La Paz, Bolivia. Their structures were elucidated by extensive NMR and MS spectroscopic analyses. The isolated compounds were evaluated for their cytotoxicity and apoptotic capacity against four human cancer cell lines. 2-Benzyl-3-thioxohexahydropyrrolo[1,2-c]imidazole-1-one (1) showed slight cytotoxic activity against all the cancer cell lines which were tested, with IC50 values ranging from 27.45 ± 0.80 to 31.07 ± 0.87 µM. Moreover, N-(4-acetyl-5-methyl-5-phenyl-4,5-dihydro-1,3,4-thiadiazol-2-yl) acetamide (2) showed significant anti-cancer potential, with IC50 values between 1.26 ± 0.57 µM and 1.37 ± 0.09 µM against all human cancer cell lines which were tested. Treatment of tumour cell lines with the compounds caused an increase in the apoptotic rate of these cells, observing that compound 2 presented an apoptotic effect which was double with respect to the control (Dimethylenastron).

Jealousy and violence in dating relationships: gender-related differences among a Spanish sample.

The present study analyzes violent behavior (psychological, physical, and sexual violence) that may occur in dating relationships. Data was collected from couples of adolescents and young adults in a sample of 579 students from the region of Madrid, consisting of 319 females and 260 males aged between 12 and 22 years. A novel aspect of this study compared with the great majority of published studies is analysis of a) the frequency of violent behaviors (and not only their presence or absence) to study significant mean differences and b) potential gender and age related differences in the patterns of violence. Results indicate the high prevalence of violence in Spanish dating relationships. Specifically, females carry out more mild physical (p < .001) and psychological violence (p < .05), whereas males perpetrate more sexual violence (p < .001). However, with regard to victimization, no significant gender related differences in frequency were found between boys and girls in any type of violence. With regard to age, young adolescents perform (p < .05) and suffer (p < .01) significantly more jealous behavior, whereas the young adults of our sample commit and suffer more sexual violence (p < .05). Directions for future research are outlined, mainly concerning instruments used that ought to be more sensitive to the reality being measured.

El incivismo y el acoso sexual en el trabajo: impacto en la salud ocupacional / Incivility and sexual harassment at the workplace: occupational health impact

En los últimos años ha habido un incremento en el interésy en las investigaciones en torno al tema de la agresiónlaboral, al ser un problema serio de salud ocupacional quetrae consecuencias negativas tanto para los trabajadores comopara las organizaciones. Objetivo: analizar las relacionesentre diferentes formas de agresión laboral (incivismo y acososexual), las conductas contraproducentes y la satisfacciónlaboral. Metodología: estudio de tipo transversal, en elque participaron 460 trabajadores del sector servicios de laComunidad de Madrid, España. Se les aplicaron cuestionariosde autoinforme para evaluar su posible exposición a situacionesde agresión laboral, así como su nivel de satisfacción con eltrabajo y la manifestación de comportamientos negativoshacia la organización. Resultados: se encontró una asociaciónnegativa y significativa entre las diferentes formas de agresiónevaluadas y la satisfacción laboral y una asociación positivay significativa entre las formas de agresión y las conductascontraproducentes. Conclusiones: la agresión laboral puedetener consecuencias negativas para la organización, queafectan la satisfacción de los empleados y facilitan la expresiónde conductas contraproducentes; por lo tanto, es importante,dentro del campo de la salud ocupacional, la implementaciónde programas de prevención de la agresión laboral, así comode protocolos claros de intervención en caso de que surja.

In recent years, interest and research on workplace aggressionhave increased, since it is a serious occupational healthproblem with negative consequences for both employeesand organizations. Objective: to analyze the relationshipsbetween different forms of workplace aggression (incivilityand sexual harassment), counterproductive work behaviors,and job satisfaction. Methodology: a cross-sectional study,involving 460 employees from the services sector of Madrid,Spain. Self-report questionnaires were used to assess theemployees’ potential exposure to workplace aggression, aswell as their level of job satisfaction, and the manifestationof negative behaviors towards the organization. Results: asignificant negative association was found between the studiedforms of workplace aggression and job satisfaction. Likewise,a significant positive association between the forms ofworkplace aggression and counterproductive work behaviorswas also found. Conclusions: workplace aggression may havenegative consequences for a company. It can affect employeesatisfaction and encourage counterproductive behaviors.Therefore, it is important, within the field of occupational.

Variables psicosociales y cáncer de mama: un estudio cuasiprospectivo de la personalidad tipo c / Psychosocial variables and breast cancer: A quasi-prospective study of type c personality

El artículo examina la relación entre personalidad tipo C, o propensa al cáncer, y desarrollo del cáncer de mama,mediante dos de sus características más consistentes: la falta de expresión de emociones negativas (o racionalidad) y la necesidad de armonía. A una muestra de 480 mujeres, de edades comprendidas entre los 20 y 68 años, que habían asistido a revisión mamaria se les administró la escala de Racionalidad/ Defensividad Emocional y la escala de Necesidad de armonía,ambas de Spielberger (1988). La recolección de datos se realizó antes de que las mujeres fueran informadas sobre su diagnóstico (diseño cuasi prospectivo, ya que la enfermedadpodría estar presente). Los datos muestran que las pacientes con cáncer de mama obtuvieron puntuaciones más altas en ambas escalas que las mujeres con patología benigna o conmamas normales (p <. 01). Adicionalmente, se identificaronotras asociaciones significativas entre las escalas y las variables de edad, nivel educativo y maternidad. Estos resultados deben ser tomados con precaución, ya que se necesitan másinvestigaciones controladas para determinar el papel de las características psicosociales en el inicio del cáncer de mama.

This article examined the relationship between type C personality and the development of breast cancer.Two characteristics has been reported consistenly in the literarature: suppression of negative emotions (orrationality) and need for harmony. The Rationality/ Emotional Defensiveness and Need for Harmony Scales(Spielberg, 1988) were administered to 480 women (20-68 years old) whom was examined for breast cancer screening. It was administered prior to knowledge of the diagnosis(quasi-prospective design, because the disease may be present). Women with breast cancer had substanciallyhigher scores than healthy and benign control groups in the two scales (p<.01). However, another variableshas been found related to the variability of these scales (age, education level, and maternity). Thise findings areto be interpreted with caution because more controled research is need to determine de role of the psychosocialcharacteristics in the breast cancer onset.